This document summarizes a study that evaluated the impact of peer counseling by mother support groups on infant and young child feeding practices in Lalitpur District, India. The study involved training mother support groups to conduct home visits and counseling sessions, which resulted in significant improvements in several feeding practices after 2 and 5 years, such as exclusive breastfeeding rates increasing from 11% to 71%. The program was found to be effective and able to sustain positive results with continued reinforcement, counseling, and support. It cost approximately $4.70 USD per birth to implement, presenting the program as a promising model for improving child nutrition outcomes at scale.

1. Effect of peer counselling by mother support groups on
Infant and Young Child Feeding practices: The Lalitpur
Experience
Kushwaha KP, Sankar J, Sankar MJ, Gupta A, Dadhich JP,
Gupta YP, Bhatt GC, Ansari DA, Sharma B.
PLOS One 2014, 9(11):e109181

2. • Department of Pediatrics,
B.R.D. Medical College, Gorakhpur
Baby Friendly Community/ Health Initiative
(BFCHI Project) in Lalitpur District of UP - INDIA
District Administration,
Lalitpur
One to one or group counseling as a service
delivery - Counseling centers and
Community

3. • Objective: To evaluate the effect of peer
counseling by mother support groups (MSGs)
in improving the infant and young child
feeding practices in the community.
• Rationale: Peer support has not been tried at
a scale of a district given the knowledge that
BF and CF contribute to child health and
nutrition.
Objectives and Rationale

4. • This was a quasi-experimental before and after
study conducted over a period of 5 years (Dec
2006-2011) by Department of Paediatrics, BRD
Medical College, Gorakhpur in collaboration with
UNICEF office of UP
• The study population comprised of mother infant
pairs
• The intervention comprised of counseling and
providing support to these mothers by the MSGs
• Both facility and community based strategy were
used
Methods

5. Step 1
• Assessment of IYCF practices in 6 blocks of district Lalitpur (pre intervention
research)
Step 2
• Develop consensus on the goal, purpose, objectives, expected results of the BFCHI
plan of action (protocol development)
Step 3
• Co-ordination with ICDS, Health, NGOs, local leaders, primary school teachers in
order to develop MSGs (capacity building)
Step 4
• Training of resource persons (middle level trainers) using IBFAN/BPNI “3 in 1”
modules
Methods

6. Step 5
• Training of MSGs by middle level trainers 3 day course
Step 6
• Setting up of village resource centers, 6 block IYCF centers (2 IYCF counsellors available
for 6 hrs/day) and referral center for referred cases from field
Step 7
• Home visits by MSG members (10 visits in first 6 months, 6 visits in next 6 months and
3 visits in 2nd year)
Step 8
• Counselling and helping mothers with feeding difficulties and reinforcing optimal
practices
Step 9
• Re-assessment of outcome variables of interest in the community
Methods

7. Results
11%
33%
7%
54%
4.5%
71%
85%
50%
85%
36%
62%
95%
60%
96%
42%
0%
20%
40%
60%
80%
100%
120%
Initiation of
breastfeeding within
one hour of birth
Not using Pre Lacteal
feeds
Exclusive
breastfeeding for 6
months
Initiation of CF (6-8
months)
Complementary
foods along with
continued
breastfeeding upto 2
years
Pre-intervention (T0 Baseline) N=421
Post –intervention (T1 2 yrs after intervetion) N=480
Post-intervention (T2 5 yrs after intervention) N=597

8. Evalution in July 2013
It showed achievement of success
of the project and sustained
results as improved feeding
practices
Factors that contributed included
training and supervision, sector
meetings each month and
reaching out to the unreached.
Lessons Include: Constant
reinforcement at health facility
and home visits helps, quality of
counselling determines the
outcomes, and challenging to
maintain motivation of volunteer
mothers without honorarium.

9. • ~ INR 314/ 4.7 US $ per birth
• This includes training, training material, refresher
training, minimum honorarium for workers BUT does
not include cost of services.
• Capacity building of States to lead this effort
• MAA Programme of MOHFW has taken on 4 days
training of ANMs, similarly AWWs should be trained
and peer support women.
Implications for scaling up

10. • A significant improvement in the Infant and
young child feeding practices is possible when
pregnant and lactating mothers are supported
with skilled counselling through home visits.
• Investment in HR and funding need to made.
• It costs ~300 INR per birth
• Results could sustain with such model as in
Lalitpur.
Conclusions